强度grated care is characterized by a proactive and person-centered approach to care, which is seamlessly coordinated across multiple professional disciplines and care interfaces. Integrated care aims to improve outcomes such as functioning, quality of life, and quality of care. The organisation of integrated primary and community care is considered an essential step towards supporting older people to age in place.

Maintaining people’s safety at home

To support older people living at home, it is essential to maintain their safety. Older people encounter limitations in multiple domains of life, which could pose risks to their ability to live safely and independently at home. Such risks may relate todifferent factors，，，，在cluding people’s functioning and behavior, their physical and social environments, and the health and social care they receive. This wide range of risks could lead to a multitude of problems that challenge people’s safety at home, ultimately resulting in emergency department visits, (re)hospitalization, institutionalization and mortality. Given its proactive, interdisciplinary and comprehensive character, integrated care is expected to provide opportunities to addressthe prevention of such risks。

我们最近发表的范围评论在BMC Geriatrics表明，为居住在家中的老年人综合护理计划解决了广泛的安全风险。在根据图1所示的预定义概念框架进行了检查之后，调查结果表明，所有程序均涉及与人们的功能和行为有关的风险，以及几个程序解决了与人们的健康和社会护理管理相关的风险。较少的计划解决了与人们的社会和身体环境有关的风险。但是，随着在家中接受护理和支持的人数不断增加，与人们的社会经济状况相关的风险，他们的家庭环境以及增加的护理人员责任正在变得越来越突出。因此，解决此类风险很重要，尤其是因为老年人自己也表达了他们的担忧regarding these issues.

及时确定风险，再加上相关的临床，行为和环境干预措施以及支持，以及护理协调或病例管理，将增强护理提供者在家中支持老年人安全的能力。优先考虑这种积极主动的多维方法，需要结合来自健康和社会护理学科的专业人员的专业知识。但是，我们的范围审查表明，健康与社会护理之间的这些联系尚不在居住在家的老年人的综合护理计划中。投资协作技能以及专业化的动态以及解决合作的财务和组织激励措施，被认为是必要的加强这些联系。

平衡安全性，自主权，护理质量和生活质量

This review showed that integrated care programs can potentially incorporate many ways of addressing and preventing risks. However, it remains challenging to priorities these activities in a way that is meaningful for older people. Adopting a person-centered way of working, in which professional expertise is tailored to people’s individual needs and preferences, is considered one of the core components of integrated care. In this light, it is important to acknowledge that safety is not the only aspect to consider, especially in the care provided in the context of people’s homes. People’s homes are not only care settings, but the setting of their daily lives, and older people may have preferences or make choices that value quality of life over safety. This means that safety risks cannot be addressed independently of older people’s perspectives. Instead, professionals are tasked to consider their professional perceptions in combination with older people’s preferences, and find a balance between aspects such as safety, prevention, autonomy and quality of life.

真正支持人们的年龄，需要社会向更广泛的健康和福祉范式转变。

但是，实际上，这提出了对居住在家的老年人安全的责任和问责制的问题。自然，专业人士无法控制老年人如何生活和他们做出的选择。因此，专业人员不能对这些选择的不利后果负责。那么，健康和社会护理专业人员的责任到底是什么？老年人自己，家庭或社会的责任是什么？这些不同的利益相关者对不利事件的责任制如何？这些问题需要就我们对护理，预防和道德质量的看法和期望以及个人，专业和社会责任和问责制进行广泛的辩论。

Expanding the health care paradigm

最后，综合护理提供了一种平台和工具，可以进一步利用，以支持居住在家里的老年人的安全性，即在安全性与对老年人重要的其他价值观之间取得平衡。但是，重要的是要注意，仅仅整合健康和社会护理的努力是不够的。Truly supporting people to age in place requires a societal shift towards a broader paradigm of health and well-being – a paradigm that recognizes the role that health, social, and environmental factors play in older people’s ability to live safely at home, and in which many different actors in the wider community play their part and perform their responsibilities.